Last month, the federal government recommended universal HIV testing for most U.S. citizens. Local health care providers say the new policy will be beneficial in improving communication between doctors and patients, but might tie up funds for a program without producing intended results.
The Centers for Disease Control recommended HIV testing for all citizens between the ages of 13 and 64 to identify the estimated 250,000 people in the U.S. who are infected with HIV, but don’t know it. One of the objectives for increased testing is to curb the approximate 40,000 new cases of HIV diagnosed each year in the country, according to the CDC recommendation.
“I think that there are some good aspects [to the decision] in that it increases the general public awareness of HIV … and decreases the stigma surrounding the virus,” said Dr. Alex Krist, a general family physician with Fairfax Family Practice Center.
The most beneficial result of the testing will be in opening the lines of communication with patients and their doctors about the disease and potential risk factors that might increase an individual’s chances of exposure to the virus, Krist said.
"We at the Whitman Walker Clinic believe that the new guideline from the CDC is a very good one," said Kim Mills, communications director, Whitman Walker Clinic in Arlington. "It's important to destigmatize HIV and AIDs so that it can be treated in patients like any other disease.
More routine HIV testing will help discover individuals who are at an early stage of the disease, giving that person more health care options which can greatly slow the advance of the disease, said Roy Berkowitz, a health provider educator specializing in HIV testing and risk reduction for Inova Fairfax Hospital’s Juniper Program.
“It’s a much different world now than it used to be 10 or 15 years ago when it comes to HIV,” Berkowitz said. “People are living much longer … it’s no longer something that is necessarily a death sentence.”
The CDC already recommends testing for all pregnant women because drug therapy during pregnancy can greatly reduce the chance of transmission of HIV from mother to her child.
BUT TESTING everyone, regardless of particular risk factors, might not be the best use of resources, Krist added.
“Sometimes the people who visit a general practitioner might not be at a necessarily higher risk and those people getting screened might not capture the population that has been affected most” by the virus, he said.
“As a nation, if we’re spending money testing people that don’t necessarily need to be tested when that money could be going to something like subsidized treatment for those who don’t have healthcare … this program might not reach its intended goal,” Krist said.
Berkowitz said that he was concerned that a push for more universal testing could misdirect much-needed funds that are available for those who have already been diagnosed and need treatment, but do not have health care.
"At the Alexandria Health Department, we try not to expend funds on people who are not at risk for contracting HIV by assessing their risk prior to testing, " said Debby Dimon, Public Health Nurse Supervisor for HIV/AIDs and STD programs. "We have signs up in our center about HIV testing, but we really depend on the local non-profit organizations to get the word out to communities. We partner with these organizations for different events and we are available for referrals from these organizations' outreach programs."
MORE ROUTINE universal testing might also cause anxiety in individuals, especially if those people are not informed about the virus and what a positive test may mean, according to Berkowitz. Part of the recommendation includes a push to ease regulations on testing consent and pre-test counseling.
“HIV testing always needs to be voluntary and never coercive,” Berkowitz said. “Doctors need to be careful that their patients know what they’re being tested for, because while testing is a routine thing, receiving a positive result is never routine.”
But the national spotlight given to the disease because of the new CDC recommendations could result in more attention to safer practices to prevent HIV, Berkowitz said.
“Talking about HIV is important and a big part of that is risk behavior assessment,” he said. “If more people are talking about the virus and knowing that it is out there, more folks will start thinking about making more safe decisions.”
"Anyone should be tested for HIV. We believe most strongly in people being self-empowered: they should know the risks, know if they are at risk and get tested," Dimon said. "At least 25 percent of people with HIV are undiagnosed and that is the reason for the new federal policy. "
"Due to the changing demographics of HIV/AIDs, it's hard to say that any group should be excluded from testing, " said Mills.